Diagnosis and treatment of bronchiectasis in pediatric patients without cystic fibrosis




Alejandra Munevar-Velandia, Programa de Neumología Pediátrica, Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
Juan Nofal-Ladino, Programa de Pediatría, Facultad de Medicina, Unisanitas, Bogotá, Colombia
Sonia Restrepo-Gualteros, Servicio de Neumología pediátrica, HOMI Fundación Hospital Pediátrico la Misericordia; Facultad de Medicina, Universidad Nacional de Colombia; Bogotá, Colombia
Milena Villamil-Osorio, Servicio de Neumología pediátrica, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
Oscar Ramírez, Servicio de Neumología pediátrica, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
Juan F. López, Servicio de Infectología Pediátrica, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
Natalia Vélez-Tirado, Servicio de Inmunología Clínica y Alergia Pediátrica, HOMI Fundación Hospital Pediátrico la Misericordia; Grupo de Inmunología Celular y Molecular, Universidad El Bosque. Bogotá, Colombia
Lina Castaño-Jaramillo, Servicio de Inmunología Clínica y Alergia Pediátrica, HOMI Fundación Hospital Pediátrico la Misericordia; Grupo de Inmunología Celular y Molecular, Universidad El Bosque. Bogotá, Colombia


Bronchiectasis is characterized by the permanent dilation of bronchi, clinically presenting with chronic cough, sputum production, dyspnea, and recurrent exacerbations. Bronchiectasis can occur due to genetic disorders, congenital malformations, endobronchial obstruction of infectious and inflammatory origin, and chronic aspiration, among other causes. Bronchial dilation leads to impaired mucociliary clearance, trapping particles and microorganisms in the airways. Macrophages and epithelial cells release proinflammatory cytokines that promote neutrophil chemotaxis. Neutrophils release enzymes causing epithelial cell damage, reducing ciliary motility, promoting glandular hyperplasia, and increasing mucus secretion. Persistent infection perpetuates local inflammation in bronchiectasis patients. Diagnosis requires high clinical suspicion and early detection improves clinical outcomes. High-resolution computed tomography is the gold standard for confirmation. A comprehensive medical history, initial assessments with complete blood count, total serum immunoglobulins, iontophoresis, and spirometry help assess the underlying etiology and disease severity. The primary goal is preserving lung function and halting disease progression. This involves adopting healthy lifestyles, expanded vaccination schedules, respiratory therapy, and early antibiotic use for exacerbations and colonization by specific microorganisms.



Keywords: Lung diseases. Bronchiectasis. Pediatrics. Bronchial diseases. Primary immunodeficiency diseases.




Boletín Médico del Hospital Infantil de México